Dr. Don Gajewski (right) consults with a patient and a physical therapist at Walter Reed Army Medical Center (RFE/RL)
WASHINGTON, December 19, 2006 (RFE/RL) -- At the entrance to this sprawling old brick hospital, a large banner hangs from the ceiling that reads: "Welcome to Walter Reed Army Medical Center. We Provide Warrior Care."

"Warriors" are what doctors and staff call the patients here. In these corridors, 20-year-old soldiers who were patrolling the streets of Baghdad a few days ago pass by pensioners who helped liberate Paris in World War II.

Walter Reed opened its doors in 1909 and currently has patients who served in six overseas conflicts: World War II, Korea, Vietnam, the 1990 Persian Gulf War, Operation Enduring Freedom in Afghanistan, and Operation Iraqi Freedom.

"Being in Iraq was so much easier," one doctor says. "I woke up every morning, did my job, patched the guys up and sent them home. Every day here you're dealing with a new guy with new family members, new decisions, and you know them for months. And it wears on you."

The elderly veterans come for routine medical care. The younger ones are almost all here because of wounds they received in Iraq.

The Road To Walter Reed

Many of them arrive unconscious or heavily sedated from the U.S. Army's Landstuhl Regional Medical Center in Germany.

That's where badly wounded soldiers are sent first, after they receive immediate care at one of the five U.S. combat support hospitals currently operating in Iraq. From Germany, they are flown back to the United States aboard giant C-17 cargo planes.

A technician working in the Walter Reed prosthetics lab (RFE/RL)

Soldiers with burn injuries are sent to Brooke Army Medical Center, in the southern state of Texas. Walter Reed takes soldiers who have lost limbs or sustained head injuries.

Many patients here have suffered both.

Most injuries in Iraq are caused by improvised explosive devices (IEDs), also called "roadside bombs." These crude but deadly bombs are hidden in piles of garbage, mounds of dirt, or even inside dead animals. Their intent is to destroy vehicles and personnel. They explode from the ground up, blowing off legs, arms, helmets.

According to the U.S. Defense Department, as of December 18, 2,936 U.S. service personnel have been killed in Iraq. Nearly eight times as many -- 22,229 -- have been wounded. Ten thousand of those have not been able to return to duty.

Three whole wards at Walter Reed are dedicated to Iraqi casualties.

Inside The Rehabilitation Department

The third-floor amputee-rehabilitation room is a bright and busy place.

Exercise treadmills and other cardio-machines are lined up in front of big windows that look out over a green lawn. In one corner, a table is laden with baked goods brought in by staff and family members.

All around the room, young, fit men lie on padded platforms, attended by physical therapists and doctors. Only one female veteran is being treated here at the moment.

It takes a moment to realize that nearly all of them are missing a limb, often two. Where a leg should be, there is a shiny metal rod that disappears into a tennis shoe. Where an arm belongs, there is instead a sharp hook.

Prosthetic limbs at Walter Reed Army Medical Center (RFE/RL)

Everyone seems to carry the telltale scars caused by IEDs. The shrapnel traces look like angry purple rashes across their arms, legs, or faces.

One soldier lies on his stomach as his legs are stretched by a physical therapist. When he turns over to lie on his back, the evidence of his injury is clear: his face appears melted, his right eye droops, and one side of his mouth is twisted down.

Captain Matt Scherer, a small, energetic man wearing army fatigues, runs the rehabilitation department. Scherer says that as soon as a wounded soldier gets approval from his doctor to begin physical conditioning, the work begins to regain strength and mobility.

"We will see them as soon as we're given the green light by their medical team," Scherer says. "We bring them down here to the clinic as soon as possible. Pre-prosthetic training includes cardiovascular conditioning, strength training, balance training, core conditioning. Wound care is also included in that, upper-body-strength training. Because what they call normal is not just being a community ambulator. For them, normal is running around downtown Baghdad in 120-degree heat [49 degrees centigrade], with 70 pounds [32 kilos] on your back, kicking down doors. That's their expectation for normal, and that is our responsibility, to get them as close to their expectation as we possibly can."

'Never Give Up'

The wounded here attack their therapy drills in the same way they attacked combat duty: with intense determination. A sign on the wall makes it clear what's expected of everyone in the room: "Never Give Up, Take One Day At A Time, Stay Focused, No Complaining."

A soldier who is missing his left arm is trying to learn to operate the hook that has replaced his hand. With his right hand he drops a piece of rope as he tries to flex his back muscles to operate the left hook. He fails repeatedly. Suddenly, the hook snaps onto the falling rope.

"I got it!" he shouts. "Look how good that was!" When he turns, smiling, his left eye is a burned-out hole.

Most amputees spend at least eight months here; some as long as two years. Over time, they look less like soldiers. But today, most of the wounded in the room are still deeply tanned from months in the desert. Their hair is military-standard short. They have powerful chests and some still wear their identification tags, maybe as a reminder of their former identities.

Scherer says most would like to go back to Iraq.

"I think it's a pretty common sentiment, that any one of these guys would get back to be with their comrades in a heartbeat if that opportunity was provided them," he says.

Metal And Molded Plastic

In one corner of the rehab room, an elderly man is talking quietly to a young veteran who has lost his right leg. Seventy-eight-year old Tom Porter comes in every day to cheer up the newest patients.

"I come to visit the amputees here, the new amputees," Porter says. "I lost both my legs in Korea [so I] try to come and help out a little bit. Probably does me as much good as it does them, but just having some old guy walk in helps more than anything anyone might say. I don't tell them that everything's going to work out. I just tell them that it's doable, and they'll be all right. Some days it'll be tough and some days it'll go easy."

Petty Officer Chad Kueser (RFE/RL)

Outside the rehab room, Naval Petty Officer Chad Kueser, a 33-year-old Iraq veteran from Garland, Texas, who lost both legs above the knee to a mortar round, is striding up and down a hallway. He is trying out his new C legs -- state-of-the art prostheses with a built-in computer that mimics the action of a human knee.

Inside the prosthetics laboratory, tables are stacked high with arms and legs. Amputees are measured for their new limbs and then workers make the first version here out of metal and molded plastic.

Some of the prosthetic limbs developed at Walter Reed are so advanced they won't be available to non-military patients for months or years. But eventually, the general population benefits from the new technology.

Lieutenant Colonel Donald Gajewski is the chief orthopedic surgeon at Walter Reed, the man who does the amputations. He spent seven months treating frontline injuries at a combat hospital in Balad, Iraq. So when he walks into the operating room here, he knows exactly where the soldier has come from.

"Being in Iraq was so much easier," Gajewski says. "I woke up every morning, did my job, patched the guys up and sent them home. Every day here you're dealing with a new guy with new family members, new decisions, and you know them for months. And it wears on you. But, you know, the healing process works, and they meet a bunch of other people. They see all the other stages of therapy and they start dealing with it a little bit better. As their surgeon, we see that over and over every week. So it's like starting over every time with new issues, new family issues, new surgical issues, things like that. So it's pretty tough."

'A Difficult Decision'

Most of the time, Gajewski's patients are young men in their 20s whose main fear is that he will cut off their leg or arm.

He explains that, in many cases, taking off a limb is a better choice than leaving it on, because the injury has rendered the natural limb useless. With a prosthetic, he says, most patients can hope to lead a fairly normal life.

"There's probably a lot of people in this room whose limb we could have saved," Gajewski says. "But would it have been worth it? Are we really doing something for them? I can save a limb, but if you're not going to use it and you're not going to get up on it and it's going to be painful for you every day, what's the point? So I always tell my patients, it's not what we're going to do to you, it's what we're going to do for you. And that's a difficult decision sometimes."

On the way out of the rehabilitation room, one can't help notice a poster taped to a bulletin board advertising an offer from the global shoe company, Nike. Their "One Shoe Bank" offers any U.S. military veteran who has lost a leg one new free athletic shoe every year for life.

It is small consolation for the loss these soldiers have suffered, but it is a show of support and respect. For these veterans, that is worth far more than the shoe itself.

On The Verge Of Civil War

The Imam Al-Mahdi Army on parade (epa)

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